Back to the Future? Abortion Before & After Roe
Ted Joyce, Ruoding Tan and Yuxiu Zhang
Next year marks the 40th anniversary of the U.S. Supreme Court decision in Roe v. Wade. We use unique data on abortions performed in New York State from 1971-1975 to analyze the impact of legalized abortion in New York on abortion and birth rates of non- residents. We estimate that abortion rates declined by 12.0 percent for every hundred miles a woman lived from New York in the years before Roe. If Roe were overturned average travel distance to the nearest abortion provider would increase by 157 miles in the 31 states expected to prohibit abortion. Under this scenario abortion rates would fall by 14.9 percent nationally, resulting in at most, 178,800 additional births or 4.2 percent of the U.S. total in 2008. A ban in 17 states would result in a 6.0 percent decline in abortions and at most, 1.7 percent rise in births.
August 2012
Acknowledgements
This study has been supported by a grant from the National Institute of Child Health and Human Development (NICHD) to the Research Foundation of the City University of New York (1RO3HD064760-01). We thank seminar participants at RAND, the Guttmacher Institute, and Baruch’s School of Public Affairs for comments and Phillip Levine for detail suggestions.
Ted Joyce Ruoding Tan Yuxiu Zhang, PhD NBER-NY& Department of Economics Health Policy and Admin Baruch College, CUNY Graduate Center, CUNY Yale School of Public Health 365 Fifth Ave, 5th Floor 365 Fifth Ave, 5th Fl 60 College St NY, NY 10016 NY, NY 10016 New Haven, CT 06510 [email protected] [email protected] [email protected]
I. Introduction
Next year marks the 40th anniversary of the U.S. Supreme Court decision of Roe v.
Wade, the decision that legalized abortion in the United States. It is hard to exaggerate its
divisive impact on U.S. politics broadly and on the abortion service industry specifically.
Abortion clinics have been firebombed, physicians murdered, and abortion patients frequently
walk a gauntlet of protesters on their entrance to a facility (Jacobson and Royer 2011). And yet
despite the controversy and violence, and despite the advances in hormonal contraceptives,
morning after pills, and the wider use of condoms among youth, induced abortion remains a common method of fertility control. The number of abortions peaked at approximately 1.61 million per year in 1990 but there were still over 1.21 million abortions in 2008 (Jones and
Kooistra 2011). Approximately, 43 percent of unintended pregnancies are voluntarily terminated
(Finer and Zolna 2006).
But there is uncertainty as to the future status of legalized abortion in the U.S. Since Roe, many states have passed laws that reflect a widespread antipathy towards abortion on demand.
These include financing restrictions, parental consent for minors, mandated counseling and waiting periods, required ultrasounds as well as unnecessary building codes and licensing requirements for providers. More recent legislative actions have sought a declaration that life begins at conception or when a fetal heartbeat is heard. Many analysts believe that the Supreme
Court is but one vote away from overturning Roe.
There is little doubt that a reversal of Roe would have a substantial impact on abortion and birth rates in US. The best evidence as to what a reversal might mean comes from changes in birth rates before and after legalization in the early 1970s (Levine et al. 1999; Levine 2004;
Angrist and Evans 1999). Results from these influential studies have proven to be robust and the
1
difference-in-difference research design has been the basis for much subsequent work. And yet,
without data on abortions in the pre-Roe era, it was not possible to know the impact of
legalization on abortion rates, the relationship between abortion and birth rates or even the total
effect of legalization on fertility. The latter holds because many women traveled to California,
Washington D.C. and especially to New York for abortions in the years before Roe.
Consequently, the effect of legalized abortion on birth rates extended beyond states in which
abortion became available on demand.
The importance of travel from states in which abortion was illegal to states in which
abortion was legal is dramatically illustrated by the map in Figure 1. The number in each state is
the abortion rate for residents of the state that were performed in New York in 1971-1972, the
two years before the Supreme Court decision in Roe. For instance, there were 7.6 abortions to
residents of Michigan per 1000 women 15-44 obtained in New York. In 1972 alone, 15,522
women traveled from Michigan to New York for an abortion.1
In this study we return to the period just before and after Roe to analyze the impact of legalized abortion in New York on the abortion and birth rates of women most affected by the change in New York. Despite the limited geographical focus, the data are unique and they enable us to address several questions in the reproductive health literature that have been challenging to tackle. For instance, the simultaneous relationship between the supply and demand for reproductive services has made it difficult to identify the separate effect of each.
The legalization of abortion in New York in July of 1970 provides an opportunity to assess the
impact of a plausibly exogenous change in the availability of abortion services on use by non- residents moderated in part by distance to the State. As Figure 1 demonstrates, travel to New
York for an abortion was substantial but it varied by proximity. A second supply shock occurred
1 Authors’ tabulations of data from the New York State Department of Health. See Table 1. 2
with Roe in January of 1973 as abortion providers became available in every state obviating most
travel to New York. We exploit both these changes to identify the effect of access to abortion on use.
Another empirical challenge is estimating the relationship between birth and abortion rates. There were less than 13,000 reported legal abortions in 1969 and 3,600,206 births, a legal abortion rate less than 1.0 and a fertility rate of 86.1. By 1975 the number of legal abortions had increased to 1,034,200, an abortion rate of 21.7, while the fertility rate had fallen to 66.0. 2
How much of the decline in fertility can be attributed to the increase in reported legal abortions is unknown given the lack of data on illegal abortions prior to Roe as well ongoing changes in
sexual activity, contraception, marriage, and women’s role in society to name only some of the
potential confounders evolving during this period. In an effort to estimate the effect of abortion
on fertility, we regress birth rates on lagged abortion rates in the years before Roe with distance
to New York as an instrument.
In the last section we use the relationships between the availability and use of abortion
services to project the possible impact of overturning Roe. Several legal analyses have made
predictions as to which states are likely to ban abortion if jurisdiction is returned to the states.
We compute the change in distance to the nearest legal abortion provider under various scenarios
and apply our pre-Roe estimates to predict changes in abortion and birth rates. The exercise is
clearly speculative for many of the conditions that existed in 1972 have changed, but recent
studies suggest that access to abortion services is still an important determinant of use (Colman
and Joyce 2011).
2 The abortion rate is the number of legal abortion per 1000 women 15 to 44 years of age. The fertility rate is the number of births per 1000 women 15 to 44. Sources: http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_01.pdf. Jones and Kooistra (2011). 3
Our analysis is made possible by re-discovered data on abortions performed in New
York State to residents and non-residents in the years before and after Roe. Data are available by age, race, year and state of residence from 1971 to 1975. Thus, we are able to provide a detailed analysis of access and use of abortion services and their impact on birth rates during this period of dramatic change.
We find a robust association between distance to New York and abortion rates in the years before Roe. Abortion rates fell 11.9 percent for every hundred miles a woman lived from
New York and the decline was greater for nonwhites than for whites. Our preferred estimates suggest that each abortion was associated with an decline of 0.56 births. Based on these estimates, we predict that abortion rates would fall by 14.9 percent resulting in 100,838 unintended births—or 2.4 percent of total live births in 2008—were Roe overturned and 31 states banned abortion. If we assume that each abortion is associated with one less birth, an obvious upper bound, then the number of unintended births rise to 178,804 or 4.2 percent of the national total. These declines seem modest, but plausible. Even with a ban in 31 states, the average distance to an abortion provider increases by only 157 miles. What is apparent from the pre-Roe abortion data, is that although distance matters, women were willing to travel hundreds of miles to terminate an unwanted pregnancy. We predict that most women would continue to travel long distances to terminate a pregnancy, if abortion were no longer legal in their state.
II. Background
Early studies on the impact of legalized abortion were largely descriptive, limited to one or a few states, or they did not account for ongoing trends in fertility (Melton et al. 1972; Smith et al. 1973; Paktar et al. 1973; Sklar and Berkov 1974; Quick 1978; Joyce and Mocan 1990).
Levine et al. (1999) and Angrist and Evans (1999) were the first to provide a more
4
comprehensive analysis of legalized abortion on fertility rates across all 50 states and over a
longer period. Both studies used a difference-in-difference framework by comparing variation in fertility rates in states that legalized abortion or reformed their abortion laws in the years before
Roe relative to states in which abortion remained illegal. Levine et al. (1999) analyzed changes
among all women and then separately by age whereas Angrist and Evans (1999) focused on changes in teen fertility. Both studies found that birth rates declined by approximately 4 percent more in the early legalizing or reform states relative to the states in which abortion did not
become legal until Roe. Both studies also found that birth rates of nonwhites fell more than
those of whites. Neither study analyzed changes in abortion rates directly due to a lack of data.
However, Levine et al. (1999) reported that birth rates fell more among women who lived more
than 750 miles relative to women who lived within 750 miles of an early legalizing state. The
association suggested that travel distance and abortion rates were inversely related.
The difference-in-difference estimator employed by Levine et al. (1999) and Angrist and
Evans (1999) provides unbiased estimates of the relative changes in birth rates in states that
legalized or reformed abortion laws relative to states in which abortion remained illegal. But the
DD cannot estimate the absolute decline in birth rates in the non-legalizing states induced by
legislation in, say, New York or California.3 Consequently, the total effect of legalized abortion on fertility was undoubtedly greater than the roughly 4 percent decline reported by these authors.
In fact, access to abortion services in the years before Roe was more extensive and at the
same time more variable than is captured by a zero-one indicator of legality or reform. For
example, none of the aforementioned studies considered the District of Columbia (DC) as an
3 Levine (2004) uses changes in birth rates by distance to the nearest legalizing state to tease out an estimate of the total effect of legalized abortion on fertility. But he did not include distance to DC or some key reform states such as Kansas, Maryland and Oregon as discussed below. 5
early legalizing or reform state.4 And yet, in 1972 there were 38,868 reported legal abortions in the District, the most of any state after New York and California. Moreover, there were more abortions to non-residents performed in DC (21,101) than there were to non-residents performed in California (20,201). In addition, states that reformed their abortion laws before Roe but were not considered early legalizing states also varied greatly in the number of abortions that were performed and the proportion obtained by non-residents. Maryland and Georgia both reformed their abortion statutes and yet the abortion ratio in Maryland in 1972 (178 abortions per 1000 live births) was over five times greater than in Georgia (29 abortions per 1000 live births). The
abortion ratio in Kansas, another reform state, was double that of Maryland (369 vs. 178), but 63
percent of abortions in Kansas were to non-residents, whereas only 2 percent of abortions in
Maryland were to non-residents (Center for Disease Control 1974).
In summary, the patchwork of legal abortion services in the years before Roe has made it
difficult to isolate the effect of legalization on reproductive outcomes. New York and California
were not the only jurisdictions in the continental US where non-residents could obtain abortions.5
As a result, previous studies may have had underestimated the change in fertility associated with early legal access. In this study, we first estimate the impact of abortion legalization in New
York on the abortion rates of non-residents obtained in New York from the period before and after Roe. We then focus on a subset of states for which New York was the likely source of legal abortion services in the period before Roe and estimate the direct association between birth and abortion rates and its implications were Roe overturned.
4 The exceptions are Joyce (2004; 2009) and Myers (2012). 5 Washington, an early legalizing state, had a residency requirement which greatly limited access to non-residents. 6
III. Empirical Implementation
III.A Data
III.A.1 Abortions
Data on abortions come from the New York State Department of Health. Analysts form the State provided aggregate data on abortions performed in New York from 1971 to 1975 by state of residence, age (<20, 20-24, 25+), race (white, nonwhite) and year. However, the age categories differed slightly stratified by race (<20, 20-29, 30+). To appreciate the exceptionality of these data, it is important to realize that there exists no population-based data on induced abortions by age, race and state of residence in the US today. The Centers for Disease Control and Prevention (CDC) annual surveillance summaries report abortion by state of occurrence cross-tabulated by age or race but not by state, age and race. The Guttmacher Institute’s survey of abortion providers collects data on the total number of abortions by state of occurrence in selected years. The Guttmacher Institute estimates the distribution of abortions by state of residence and age based on data from the CDC. Some states make available individual-level records on induced abortions that can be aggregated into detailed cells (Joyce, Kaestner and
Colman 2006). However, there is no reciprocal reporting agreement for induced abortions among states as there are with births. As a result, abortions to residents of one state that occur in another are rarely reported back to the state of residence. In sum, the New York State abortion data are matchless not only because they pre-date Roe, but because they are even more detailed than abortion data currently collected.
7
III.A.2 The Importance of New York
The focus on New York is driven only partly by the availability of data. New York was
the overwhelming destination for women wishing to terminate a pregnancy in the pre-Roe years.
In 1971, for example, abortion on demand was effectively available in Alaska, California, the
District of Columbia, Hawaii, New York and Washington. 6 Eighty-seven percent of the 480,259
reported legal abortions in the U.S. were performed in these 6 jurisdictions, but 84 percent of all
known abortions obtained outside a woman’s state of residence were performed in New York.
Table 1 lists the number of abortions by state of residence as reported by the Centers for Disease
Control in 1971 and 1972. The second column under each year shows the number and the third
column the proportion of abortions to residents of the state obtained in New York. With
relatively few exceptions, if the state had not legalized or reformed abortion laws, then the vast
majority of abortions to residents of the state were performed in New York. Many of exceptions
have plausible explanations. For instance, Iowa, Missouri, Nebraska and Oklahoma all border
Kansas, a reform state in which 63 percent of abortions were to non-residents. There are also
changes between 1971 and 1972. Texas, for instance, reported 2,558 abortions in 1971, 92
percent of which were obtained in New York. In the next year, there were 16,022 reported
abortions to residents of Texas but only 7 percent were obtained in New York.7
6The California Supreme Court case in People v. Belous (September, 1969) resulted in de facto legalization in California. This decision was followed by repeals in Hawaii (effective March 1970), New York (July, 1970), Alaska (July, 1970) and Washington State (December 1970). Abortions became available at outpatient clinics in Washington DC in 1971 following the decision in US v. Vuitch (April 1971). For details, see Garrow (1998) and Lader (1973). By 1970, 11 states, AR, CO, DE, GA, KS, MD, NM, NC, OR, SC and VA had reformed their laws following guidelines outlined by the American Law Institute (ALI) which allowed women to terminate a pregnancy even if the mother’s life was not endangered (Centers for Disease Control 1971). Evidence suggests these ALI reforms had no significant impact on birth rates (Levine et al. 1999).
7 Another anomaly occurs when the CDC reports fewer abortions to residents of a state than does New York. We cannot explain this discrepancy since the CDC surveillance is ostensibly collecting data from all reporting states on abortions performed in a state and assigning women to their state of residence (CDC 1972, 1974). For instance, there were no reported legal abortions to residents of Michigan obtained in Michigan in 1972. The CDC reports 8
We use the detailed data on abortions from New York in two ways. First, we associate
resident abortion rates performed in New York with distance to New York from 1971-75. This
exploits two exogenous changes in the availability of abortion services. Legalization in New
York prior to Roe induced many women to come to the State to terminate their pregnancies. But then national legalization with Roe rendered such travel largely unnecessary. The change in these flows before and after Roe helps calibrate the importance of travel distance on the use of abortion services.
We then use the data from New York to associate age and race-specific birth rates with lagged values of age and race-specific abortion rates. However, in these analyses we limit the sample to 1971-72 because abortions performed in New York are only relevant to resident birth rates in the years before Roe.8
III.A.3. Distance
To proxy the availability of abortion services in New York we compute the straight line
distance in miles from the population centroid in each county to the nearer of Buffalo, New York or
New York City. We then average the county distances within each state weighted by the population
of women 15 to 44 years of age in the county to arrive at the average distance to the nearest abortion
provider in the state. For residents of New York, we compute the average distance from the
population centroid of the county of residence to nearest county with an abortion provider based on
the distribution of abortion providers in 1973 within the state. That was the first year the Guttmacher
Institute collected data on the number of abortion providers by county. We average the county-level
14,626 abortions to residents of Michigan obtained in other states in 1972. However, the New York State Department of Health alone reports 15,522 abortions to residents of Michigan obtained in the state. 8 Resident abortion rates by state are available from the Guttmacher Institute beginning in 1973, but they do not vary by age or race. The focus of this study is the impact of legalized abortion in New York in the years before Roe. 9
distances weighted by the county-level population of women 15 to 44 years of age to arrive at the
average distance to the nearest abortion provider within New York.
The average distance in hundreds of miles from each state to the nearest of either Buffalo,
New York or New York City is displayed in Figure 2. We have organized states into three
grouping. We assume that women from the 13 darkest-colored states were the most likely to
obtain legal abortions in New York prior to Roe. This is based on proximity and the proportion
of all known resident abortions obtained in New York (see Table 1). The mean distance to New
York was 233 miles among the 12 states excluding New York ranging from a low 35 miles in
New Jersey to a high of 506 miles in Illinois. The lightest colored states are states that either
repealed or reformed their abortion laws prior to Roe (Arkansas, California, Colorado,
Delaware, District of Columbia, Georgia, Kansas, Maryland, New Mexico, North Carolina,
Oregon, South Carolina, Virginia and Washington). For women in the remaining states, New
York was the most likely destination for an abortion but not the only source of legal services (see
for example Iowa and Minnesota in Table 1).
III.A.4 Birth and other data
Data on births are from the National Center for Health Statistics national natality files.9
We create abortion and birth rates by dividing the number of each by the number of women in the relevant state, year, age and racial group. Population is from the Surveillance
Epidemiological and End Results (SEER) from the National Cancer Institute. We also include state controls for the percent poor, the percent nonwhite and the unemployment rate as well as
9 Natality vital statistics were obtained from the website of the National Bureau of Economic Research. http://www.nber.org/data/vital-statistics-natality-data.html
10 indicators of whether states allowed women less than 21 to obtain the contraceptive pill without parental consent.10
III.B Statistical models
We estimate two models. In the first we analyze the association between resident state abortions performed in New York and distance to the either Buffalo or New York City from
1971-75. In the second set of regressions we estimate the direct effect of lagged abortion rates on birth rates in the two years before Roe.
III.B.1 New York 1971-75
We first regress abortion rates by state of residence in the 48 continental states and the
District of Columbia on distance to New York from 1971-1975. We include only abortions performed in New York. In general, the further women resided from New York, the lower the abortion rate. Exceptions include states in which abortion was legal on demand or states in which reforms of abortion statutes permitted hospital committees to approve induced terminations under selected circumstances (see footnote 6 and Table 1). After Roe in 1973, travel to New York for an abortion fell off rapidly. Figures 3 and 4 show resident abortion rates for abortions obtained in New York in 1973 and 1975, respectively. Even in 1973, proximity to
New York mattered. The closer a woman lived to New York, the more likely she was to obtain abortion services in the State. For instance, the rate of abortions obtained in New York for residents of Connecticut fell from 9.8 in 1972 to 6.0 in 1973, a decline of 39 percent. In
Michigan, by contrast, the rate fell from 8.0 to 1.4, an 83 percent decline (Figure 3). At the same time, the total resident abortion rate in Michigan rose to 18.3 in 1973 (Forrest, Sullivan and
10 We thank Phil Levine for the state-level covariates and Melanie Guldi for sharing her coding on access to the pill (see Guldi 2008). 11
Tietze 1979). By 1975, virtually no one that resided in a state that did not border New York
obtained an abortion in the state (Figure 4). To capture these changes in access on abortion rates,
we estimate the following regression.
(1) Abrate jt 1D j * 7172 2 D j * Ref * 7172 3D j * Rep * 7172
4 D j * 7374 X jt β j t e jt
Let Abratejt be the abortion rate for a specific age or racial group in state j and year t that were
performed in New York; let Dj be distance to an abortion provider in New York; let 7172, 7374
be year dummies with the omitted year being 1975; we use both the natural log of distance as
well as distance entered in miles. Ref is 1 if the state had reformed its abortion laws and Rep is one if the state had repealed its abortion laws. We include three controls for state characteristics
(X): the insured unemployment rate, per capita income, the percent of the population that was nonwhite. The X matrix also includes the full set of first-order interactions. 11 We also include a
dichotomous indicator of whether state policies allowed women less than 21 years of age to
obtain the contraception pill without parental consent (Guldi 2008). The last two terms capture
the main state (λj) and year ( τt) fixed effects. Because distance to New York does not vary
overtime, it can only be included as an interaction term in models with state fixed effects. Thus, the coefficient, α1 captures the change in abortion rates among non-residents of New York in
non-repeal and non-reform states in 1971-72. We expect α1 to be negative. The association
between distance and abortion rates in reform states (α1 + α2 ) should also be negative but the sum
should be less than α1 in absolute value since there was some access to legal services in reform
states which may attenuate the effect of distance to New York. The association between distance
11 These include Ref*1971-72, Rep*1971-72, NY*1971-72 Ref*1973-74, Rep*1973-74, NY*1973-74. Note that New York is entered as a separate repeal state. The other three repeal states are CA, DC and WA. 12
and abortion rates in repeal states (α1 + α3 ) is ambiguous and may be statistically insignificant
since women in repeal states would have had no need to travel to New York. The coefficient on
α4 captures the association between distance to New York and abortions to non-residents in non- repeal and non-reform states performed in New York after national legalization. There would be
no association if non-residents of New York obtained all abortions in their own state or a state
other than New York. However, this depends on the speed with which abortion providers
outside of New York were able to offer services after Roe. As noted previously women who
resided in states that border New York continued to travel to New York after Roe while the
market for abortion services developed locally (see Figures 3 and 4).
III.B.2 Birth rate regressions 1972-73
Unlike distance, the abortion rate varies by state, year age and race and may be a better
proxy for the availability of abortion services in the pre-Roe years.12 Thus, we also estimate the
direct effect of the abortion rate lagged one year on the birth rate as follows:
(2) Brateajt α0 Abrateajt1 a Aa X jtβ λ j τt eajt where Brateajt is the resident birth rate of age group a, in state j and year t for 1972-73 and
Abrateajt-1 is the resident abortion rate of abortions obtained in New York in 1971-72 also by age, state and year. The X matrix includes the same set of state characteristics as in equation (1) plus the set of first-order interaction between age and states (∑Aa*Reform, ∑Aa*Repeal). We estimate equation (2) for all three age groups, two years and 49 states which includes the District of Columbia (n=294), and then separately for the subsample of 13 states (n=78) for which we
12 Goldin and Katz (2002) also use the abortion rate as a proxy for the availability of abortion services in the 1970s as an alternative to a dichotomous indicator of legalized abortion. 13
considered New York the relevant “catchment area” in the years before Roe (See Figure 2). We
also estimate equation (2) for white and nonwhites separately.
We expect the coefficient on the lagged abortion rate, α, to be less than 1.0 in absolute
value. Each abortion should replace less than one birth given fetal loss and the substitution of
legal abortions for illegal abortions (Joffe 1995; Tietze 1973). However, not all legal abortions
were obtained in New York prior to Roe. This is especially true in the states that reformed or
repealed their abortion laws prior to Roe. Yet even in non-reform states such Iowa and Nebraska,
the proportion of abortions obtained in New York was less than 70 percent. It is also possible
that some legal abortions were not reported to the CDC as surveillance systems were new.
Thus, estimates of α could be greater than one in absolute value if the number of reported legal
abortions obtained in New York was only a proportion of all the new legal abortions that
occurred in 1971-72. Given these sources of underreporting, we take two approaches. We
anticipate that measurement error will be less in the 13 states that are close to and including New
York. (Table 1). Estimates of α for these 13 states should be closer to or less than 1.0 in absolute
value than in the sample of 49 states. The second strategy is to instrument the abortion rate with distance to New York. We recognize that an instrumental variables approach is challenging given just two years of data. Thus, we stack the abortion rates by age and interact distance with age. The first stage becomes a modification of equation (1).13
(3) Abrate ajt a Aa a (Aa * Dis j ) a (Aa * Dis j * Rep) a (Aa * Dis j * Ref )
Xβ j t eajt
13 The X matrix includes a set of first order interactions of Aa*Reform, Aa*Repeal, ,Dis*Reform, Dis*Repeal. The excluded instruments include all interactions with distance.
14
The validity of distance to New York as an instrument rests on several factors. First, the
law’s passage was unexpected. It carried by one vote and only after a state assemblyman changed his vote in a dramatic session.14 Second, the New York statute represented a significant
and exogenous change in the availability of legal abortion services to residents of states in which
abortion was prohibited, which minimizes contamination from policy endogeneity. Third,
distance to New York is only a determinant of state abortion rates in the period before Roe and
largely irrelevant afterwards. In other words, the legalization of abortion in New York was an
unanticipated, transitory increase in the availability of abortion services. The dramatic decline in
abortions to non-residents performed in New York after Roe is illustrative (see Figures 3 and
4).15 These points also suggest that distance to New York satisfies the assumption of
monotonicity, since there are likely few “defiers:” women who would not travel to New York for
an abortion before legalization, but who would travel to New York when legal services became
available in their own state.
Arguments against distance to New York as a valid instrument begin with New York’s
more liberal politics. It is not surprising that New York, like California, legalized abortion
before Roe. The classic blue-state, red-state map of American politics suggests that abortion
policies become more conservative, the further one moves from either coast (Joyce 2011). As a
standard correction, we estimate models with state-fixed effects, which should capture time-
invariant differences between states in the short study period (1971-72). Another argument
14 State Assemblyman George Michaels switched his vote from negative to positive after an emotional conversation with his son. Moreover, complete legalization caught the Catholic Church by surprise. Legalization had seemed so implausible that the Catholic Church had been lobbying to contest a much less liberal bill (Garrow 1998; Lader 1973).
15 This also explains why distance to New York has never has been included as an independent covariate in studies of state abortion and birth rates in the period after Roe, further support for the exclusion restriction (see Matthews, Ribar and Wilhelm 1997; Kane and Staiger 1996; Levine et al. 1996; Blank et al. 1996).
15
against the validity of the instrument is the violation of the stable unit treatment value
assumption (SUTVA). For instance, there may have been capacity constraints in the provision of
services in New York in 1971-72. Thus, some women’s use of abortion services may have
prevented other women from terminating a pregnancy.16 In sum, distance to New York may not
meet all the assumptions that define a local average treatment effect, but the unanticipated
passage of the law, the exclusion of distance to New York in models of fertility, and the
implausibility of “defiers,” provide support for its use.
IV. Results
4.1 .Graphical analysis
Figures 5A and 5B show the relationship between resident abortion rates in 1971-72 and distance to New York in hundreds of miles in the 48 states and the District of Columbia (left panel) and for the 13-state subsample (right panel). The data include only abortions performed in New York. The fitted line in Figure 5A is from a simple regression of abortion rates on the natural logarithm of distance; the fitted line in Figure 5B includes distance in miles as the sole covariate. The logarithmic specification provides a tighter fit. The R-squares in Figure 5A are twice as large as their linear counterparts in 5B. Another observation is that coefficients on the log of distance are almost the same in the 49- and 13-state samples (-3.35 vs -3.57, respectively), but the slopes differ substantially between the two samples in the linear specification (-0.48 vs. -
2.90). We also believe the logarithmic specification is conceptually superior. The linear specification forces a constant marginal effect. Thus, a 100-mile increase in travel distance for
16 There is some evidence that capacity constraints may not have been substantial. For instance, the proportion of abortions performed in New York City prior to 13 weeks was greater among non-residents than residents of New York (Pakter et al. 1973). Severe capacity constraints might have affected non-residents more than residents since the latter should have greater flexibility in scheduling a termination. 16 women who live 900 miles from New York imposes the same additional costs as does a 100-mile increase for women who live 50 miles from New York. However, the cost of flying, travel time, and outlays for an overnight stay should be relatively similar for women that reside 900 or 1000 miles from New York, which is better captured by the logarithmic specification.
The last observation is that New York appears as a distinct data point. We estimate the average distance to the nearest abortion provider to be less than a mile in New York in 1971-72, which is an order of magnitude smaller than New Jersey at 35 miles, the state with the next smallest distance to an abortion provider. Consequently, we include a separate interaction for
New York and distance in the regressions below.
4.2 Regression analysis: Abortion rates
Table 2 presents results from the estimation of equation (1). Each column is from a separate regression. The dependent variable is the age or race-specific resident abortion rate for abortions performed in New York from 1971 to 1975. The coefficient on Ln Distance*1971-72 shows the change in abortion rates per unit change in the natural log of miles from the nearest abortion provider in New York and pertains to women who resided in a state other than New
York but who did not live in a state that had repealed or reformed its abortion laws prior to Roe
(see Figure 2). To demonstrate the marginal effect of distance in 100-mile increments, we compute the difference in abortion rates for women that resided 283 verses 183 miles from the nearest abortion provider in New York (Table 2, row2). The midpoint, 233 miles is the average distance to New York in the 13-state sample excluding New York. The mean distance for the full sample is 828 miles. We compute the marginal effect of a 100-mile increase centered on that distance in row 3. As a point of comparison, we also include the constant marginal effect of
17 distance from a separate regression in which distance is entered as the number of miles (in hundreds) instead of in logs (Table 2, row 4).
The overall abortion rate falls by 0.99 abortions per 1000 women 15-44 years of age when distance increases from 183 to 283 miles (column 1, row 2). This represents a decline of
11.9 percent (-0.99/8.37) evaluated at the mean abortion rate of the 12 states for which New
York is the most likely site for legal abortions in the years before Roe. The change in abortions per 100 miles evaluated at the mean distance for the 49-state sample is -0.28 abortions per thousand women 15-44, a 6.6 percent decline at a mean abortion rate of 4.16. We contrast these changes with those based on a regression in which distance is entered linearly (row 4). The linear estimates are approximately one-third the magnitude of those based on logarithmic specification for women that lived within 280 miles of New York. This becomes important when we predict changes in abortion should Roe be overturned. As we show below, distance to the nearest abortion provider even if abortion is banned in 31-states increases from 30 to 187 miles on average. Thus, the most relevant estimate of the abortion-distance gradient is in the first 200 miles.
Another result of note is that the gradient for nonwhites is over double that of whites. For example, the abortion rate among nonwhites fell by 2.0 abortions per 1000 women or 14.4 percent given a mean abortion rate of 13.9. The comparative change among whites was a decline of -0.90 abortions, an 11.0 percent decline evaluated at the mean (Table 2, row 3, column 5 and
6). To the extent that race captures gross differences in socioeconomic status, then less advantaged women appear more sensitive to the costs associated with travel distance. The other coefficients shown in Table 2 conform to expectations. The association between abortion rates performed in New York and distance to the State falls substantially in 1973-74 as abortion
18 services became available locally with national legalization (Table 2, row5). The map in Figure 3 suggests that distance still mattered somewhat in 1973 (relative to 1975 the omitted category) especially for women in states nearest New York, but by 1975 abortion services in New York were largely irrelevant to non-residents (see Figure 4). The same is true for women in repeal states prior to Roe as there is no meaningful association between distance to New York and abortions to residents of California, the District of Columbia and Washington State performed in
New York (Table 2, row 6). The association between distance to New York and abortions obtained in New York is somewhat stronger for women who resided in reform states prior to Roe
(Table 2, row 7). In summary, estimates in Table 2 make several points: 1) the sudden availability of legal abortion services in New York in 1970 induced many women to travel to the
State to terminate their pregnancies; 2) the further a woman lived from New York, the less likely she was to terminate her pregnancy in the State; and 3) the availability of local abortion services starting in 1973 dramatically reduced the likelihood that a women travelled to New York for an abortion. What is not clear from Table 2 is whether the availability of legal abortion services in
New York simply replaced abortions that would have been performed illegally or in some other location, or whether pregnancies or some proportion of pregnancies that were terminated in New
York would have been carried to term had legal abortion services not been available in the State.
To address the latter, we turn to the association of birth and abortion rates in the years before
Roe.
4.3 Regressions: Births on Lagged Abortions
We present the direct association of birth rates and lagged abortion rates in Table 3. The top panel pertains to the sample of 49 states and the lower panel to the 13 states for which we
19 believe residents viewed New York as the most accessible source of legal abortion services. An important advantage of using the abortion rate as a proxy for the availability of abortion services is that it varies by state, year, age and race whereas distance only varies by state.
The ordinary least squares (OLS) coefficients reflect a robust negative association between abortion and birth rates in the 49-state sample (Table 3, Panel A, columns 1, 3, and 5).
The OLS coefficient is greater than 1.0 in absolute value for all women and for whites, but is -
0.59 for nonwhites. The latter indicates that every abortion replaced 0.59 births during this period. The IV estimates are about twice as large as the OLS coefficients in the 49-state sample
(Panel A, columns 2, 4 and 6). The F-statistics on the excluded instruments suggest sufficient explanatory power in the first stage (see Appendix Table 1 for the first-stage results).
Nevertheless, the IV estimates appear too large to be credible. Each abortion should not cause a decline of more than one birth.
Estimates from the 13-state sample are more plausible and closer to expectations. The largest coefficient is -1.01 in the regression of all women (Panel B, column 1) but the race- specific estimates are substantially smaller in absolute value. Moreover, the OLS and IV estimates are essentially the same. Among whites, each abortion replaces approximately 0.67 births and each nonwhite abortion replaces 0.40 births (Panel B, columns 3 and 5). Estimates from the 13-state sample are consistent with less measurement error. In other words, abortions to residents in the 13-state sample performed in New York are likely closer to the total number of resident abortions in these states than in the full sample. As such, they provide a more credible estimate of the relationship between abortions and births in the pre-Roe era.
The race-specific estimates in Panel B of Table 3 are also in line with those in Table 2.
The point estimates indicate that each abortion replaced fewer births among nonwhites as
20
compared to whites. If race serves as a crude proxy for socio-economic status, and if distance
proxies the cost of an abortion, then the racial differences are consistent with less well-off
women being more sensitive to the availability of abortion services than more advantaged
women.
4.4 Were Roe Overturned
In this section we estimate the likely impact on abortion and birth rates were the U.S.
Supreme court to overturn Roe and allow states to regulate abortion. In brief, we compute the change in distance to the nearest legal abortion provider in 2008 were a certain number of states to ban abortion. We use estimates of equation (1) to compute the decrease in abortions associated with the change in distance. Lastly, we use the relationship between abortion and birth rates to calibrate the rise in births under the various scenarios.
Projections as to which states would likely ban or severely restrict abortion comes from several analyses of states’ constitutions and current legislation.17 From these we created two scenarios. In the more extreme, 31 states including the District of Columbia ban abortion. We assume that only 20 states with constitutional protection for reproductive rights or states with historically strong support for abortion would continue to allow access as it presently exists.18
In the less extreme case abortion is banned or extremely restricted in 17 states: those with explicit bans prior to Roe; those with explicit legislation to ban abortion if Roe is overturned; or states that have indicated a desire to restrict access to abortion to the maximum legally
17 Center for Reproductive Rights. http://reproductiverights.org/sites/crr.civicactions.net/files/documents/Roe_PublicationPF4a.pdf . NARAL Pro- Choice America http://www.prochoiceamerica.org/what-is-choice/fast-facts/issues-constitutional-protection.html. The Guttmacher Institute http://www.guttmacher.org/statecenter/spibs/spib_APAR.pdf
18 These are AK, CA, CT, FL, HA, ME, MD, MA, MN, MT, NV, NJ, NM, NY, OR, TN, VT, WA, WV and WY. 21
possible.19 In each case we assume there are no legal abortion providers in states with bans and
we compute the straight line distance to the nearest provider in a state without a ban. The most
recent data on abortion providers and resident abortion rates are from the Guttmacher Institute’s
2008 provider survey. Figures 6A and 6B show the states in the continental US. In each, the
light-shaded states presume a ban on abortion. The figures in each state show the average
distance in miles to the nearest legal abortion provider. Women in Missouri, for example, would
have to travel 265 miles, on average, were 31 states to ban abortion (Figure 6A), but 133 miles
under the less extreme scenario (Figure 6B).
The change in abortions is shown in the upper panel of Table 4. We show estimates
based on a 31-state ban, a 17-state ban and lastly we show the effect of a 46-state ban. The latter
simulates the expected decline in abortion based on the pre-Roe conditions with only 5 states
considered to have abortion on demand. We show the average change in miles to the nearest
abortion provider under each scenario. Nationally abortions would be expected to fall by 14.9
percent if a ban were instituted in 31 states, but by only 6.0 percent if the ban were limited to 17
states. These are more modest declines than would be expected if there was a return to the pre-
Roe era in which 46 states banned abortion on demand.20 The difference is due to the change in distance to the nearest provider. Even under a 31-state ban average distance increases by 157 miles in the 31 states from the current distance to the nearest provider (187- 30 miles). The increase in average distance under a 17-state ban is only 69 miles in these states (107-38 miles).
These are substantially less than the 435-mile increase under a 46-state ban.
In the bottom panel of Table 4 we show the change in births associated with the decline in abortions. We compute a high and low estimate. The high estimate assumes that every
19 These include AL, AZ, AR, CO, DE, IL, KT, LA, MI, MS, MO, ND, OH, OK, SD, UT, WI. 20 We are ignoring the de facto legalization of abortion in the District of Columbia in December of 1970 (U.S. v. Vuitch) in order to make the estimates comparable to those of Levine et al. (1999) and Angrist and Evans (1999) 22
abortion replaces one birth based on the OLS coefficient for the 13-state sample in Table 4. The
low estimates assume every abortion replaces 0.56 births.21 This represents a weighted average
of the OLS coefficients for whites and nonwhites from the 13-state sample. If 31 states were to
ban abortion, we estimate an increase of between 100,000 and 179,000 births or 2.4 to 4.2
percent increase nationally. A 17-state ban would raise births by between 1.0 and 1.7 percent.
The greatest increase would be observed among nonwhites (4.1 to 7.2 percent) and teens would
experience a larger increase than older women. The last two rows show the projected change if
all states except for Alaska, California, Hawaii, New York and Washington, the original repeal
states, were to ban abortion. These estimates are approximately two times greater than those for
a ban in 31 states. The difference is a function of distance, the number of states affected, and
the number of abortions in the affected states. The five repeal states are all “salt water” states
which makes travel quite substantial for women in the south and Midwest. Under a 31-state ban,
access to services in Colorado, Florida, Minnesota, New Mexico, Tennessee, and Texas would
greatly reduce potential travel.
Our simulations are sensitive to whether we use the log of distance or whether we use
distance entered in miles. Simulations based on the latter are approximately half as large as
those obtained from the logarithmic specification. In other words, total abortions would be
expected to fall by 7.5 percent under a 31-state ban and by 1.9 percent under a 17-state ban (see
Appendix Table 2). As we argued in Section IV.4.1, we believe the logarithmic specification to
be superior.
21 In the race-specific projections of changes in births we use the white and nonwhite coefficients for the lower estimates.
23
4.5 Are these estimates plausible?
Previous analyses of abortion legalization have estimated that birth rates fell
approximately 4% more in early legalizing states relative to states that legalized abortion with
Roe (Levine et al. 1999; Levine 2004). Recall that these estimates are based on the decline in
births in the early repeal states (AK, CA, HI, NY, WA) relative to the decline in the non-repeal
states. A key point of our analysis is that many women traveled to New York, California and
the District of Columbia for an abortion prior to Roe, which had a significant impact on birth
rates in the non-repeal states. Consequently, the full effect of early legalized abortion was
greater than obtained by these DD estimators. Our results indicate that a return to a pre-Roe
regime would increase birth rates by between 4.7 and 8.4 percent (Table 4). Our low estimate is
remarkably close to those of Levine et al. (1999) and the high estimates may be a better estimate
of the full effect of legalized abortin on fertility.
Clearly there have been important changes in reproductive technology,
telecommunications, and travel costs since 1972, which render predictions as to the effect of
overturning Roe highly speculative. A rise in illegal abortion is one possibility were jurisdiction
over abortion returned to the states. However, unlike in 1971 the availability of medication abortion could make illegal abortion a more feasible option. Detailed instructions on how to obtain and use the necessary drugs are readily available online.22
Second, the cost of air travel and early-term abortions are less expensive today than in
1971. Airline deregulation in 1978 lowered airfares and the growth of specialized outpatient
abortion clinics has lowered costs in real terms. Newspaper articles from 1971 reported the cost
of an early abortion in New York at upwards of $600 when performed in a hospital to $150 in an
22 http://www.nice-a-beauty.com/where-to-buy-abortion-pills-misoprostol-cytotec.html (last accessed July 26, 2012).
24
outpatient clinic. In the first year of New York’s liberalized abortion law, 73.3% of all abortions in New York City were performed in a hospital (Pakter et al. 1973). A simple weighted average suggests a cost of $478 or $2,541 in 2008 dollars based on changes in the Consumer Price
Index.23 The median cost of an abortion at 10 weeks gestation in the U.S. was $470 in 2009
(Jones and Kooistra 2011). If we apply the Internal Revenue Service’s cost per driving mile of
approximately 55 cents in 2008 to the average increase in distance of 157 miles in the 31-states
that might ban abortion, then the average cost of an abortion for residents in states that prohibit
abortion with roundtrip travel would be approximately $643 dollars. Air travel would raise the
cost but not nearly enough to exceed the cost of accessing abortion services in 1971.
Other changes since 1972 include alternative forms of fertility control such as the
morning after pill and additional hormonal contraceptives (Martinez, Copen and Abma 2011).
Such use would likely accelerate if abortion were severely restricted. Lastly, the internet and
social media have altered the landscape since 1972. Both would greatly facilitate searches for
legal abortion providers as well as the organization of support networks for women in states that
banned abortion.
Our simulations have assumed that states would completely ban abortion. However, less
restrictive responses to overturning Roe would be limitations as to the gestational age of the fetus
at which abortions may occur, the type of facility that can perform abortions, or state residency
requirements. Since each of these caveats would attenuate the effect of a ban, the estimates in
Table 4 most likely provide an upper bound estimate as to the impact of reversing Roe.
23 A newspaper article from 1970 described a $400 package deal organized by physicians in which patients would fly from Detroit, Michigan to Niagara Falls, New York for an abortion.23 The fee included transportation. I thank Caitlin Knowles Myers for the link. http://news.google.com/newspapers?id=4kM_AAAAIBAJ&sjid=4FEMAAAAIBAJ&pg=2757,5519015&dq=buffal o+new+york+abortions&hl=en . 25
Despite these caveats, there is convincing evidence that relatively marginal changes in
access to abortion services can lower abortion rates, especially among poor, young and
disadvantaged women. Cook et al. (1999) used a unique natural experiment to show that a
sudden cutoff in public funds for abortion services decreased abortions and increased births
among Medicaid recipients in North Carolina. Colman and Joyce (2011) demonstrated that a
Texas regulation that increased the distance women had to travel for abortions at or after 16-
weeks gestation from 33 to 252 miles lowered late-term abortions by 69 percent one year after
the law. Similarly, a parental notification statute in Texas in 2000 was associated with 16
percent decline in abortion rates and a 4 percent rise in birth rates among 17- year olds. A key
factor was that all but one of the states that bordered Texas had similar requirements regarding
parental involvement, which necessitated that minors travel hundreds of miles in order not to
notify their parents (Joyce, Kaestner and Colman 2006). In sum, a reversal of Roe is unlikely to
cause drastic increases in unintended childbearing, but it would likely have a significant impact
on those with the least resources and wherewithal to adjust.
V. Conclusion
As Roe approaches 40, the number and severity of restrictions on abortion services have
escalated.24 The constitutionality of one of these policies likely will be decided by the U.S.
Supreme Court. In this study we have used data on abortions and births in the early 1970s to document the remarkable number of women who traveled to New York to legally terminate a
pregnancy in the two years before Roe. We used the estimated association between distance to
New York and changes in abortion rates to project variation in abortions and birth rates today
were Roe overturned. The out-of-sample projections are clearly speculative, but there exists
24 See http://www.guttmacher.org/media/inthenews/2011/07/13/index.html (last accessed July 26, 2012)
26
sufficient evidence to suggest that dramatic changes in the availability of abortion services can
have significant short-term effects on abortion and birth rates. And yet, despite the profound
impact of overturning Roe, we anticipate that the vast majority of women in states without legal abortion would access services in states where abortion remained accessible.
27
VI. References
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Cook, P.J. et al. 1999. "The effects of short-term variation in abortion funding on pregnancy outcomes." Journal of Health Economics, 18(2), 241–257.
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Henshaw, Stanley and Jennifer Van Vort. 1992. Abortion Factbook 1992 Edition. New York, New York: Guttmacher Institute.
Jacobson, M. and H. Royer. 2011. "Aftershocks: The Impact of Clinic Violence on Abortion Services." American Economic Journal: Applied Economics 3(1):189-223.
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Joyce, Theodore J., Robert Kaestner and Silvie Colman. 2006. "Changes in Abortions and Births and the Texas Parental Notification Law." The New England Journal of Medicine, 354(10):1031.
Joyce, Theodore J. and Naci H. Mocan. 1990. "The Impact of Legalized Abortion on Adolescent Childbearing in New York City." American Journal of Public Health, 80(3): 273.
Kane, Thomas J. and Douglas Staiger. 1996. "Teen Motherhood and Abortion Access." The Quarterly Journal of Economics, 467-506.
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Matthews, Stephen, Ribar, David and Mark Wilhelm. 1997. "The Effect of Economic Conditions and Access to Reproductive Health Services on State Abortion Rates and Birthrates." Family Planning Perspectives, 29(2):52-60.
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30
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Myers, Caitlin Knowles. 2012. " Power of the pill or power of abortion? Re-examining the effects of young women's access to reproductive control." Unpublished manuscript, Middlebury College.
Paktar, Jean et al. 1973. "Two Years Experience with New York City's Liberalized Abortion Law--Progress and Problems." American Journal of Public Health, 63(6):524-535.
Quick, Jonathan. 1978. "Liberalized Abortion in Oregon: Effects on Fertility, Prematurity, Fetal Death, and Infant Death." American Journal of Public Health, 68(10):1003-1008.
Santelli et al. (2007)
Sklar, June and Beth Berkov. 1974. "Abortion, Illegitimacy, and the American Birth Rate." Science, 185(4155), pp. 909-915.
Smith, Roy G. et al. 1973. "Abortion in Hawaii: 1970-1972." Hawaii Medical Journal, 32(4):213-220.
Tietze, C. 1973. "Two Years' Experience with a Liberal Abortion Law: Its Impact on Fertility Trends n New York City." Family Planning Perspectives 5(1): 36-41.
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30
Figure 1 : Average Resident Abortion Rates for Abortions Performed in NY, 1971-1972 Abortions per 1,000 Women Ages 15 to 44
0.1
7.6 2 1.5 7.6 0 2.9 8.4 0 8.7 0.8 2.4 29.4 10.3 7.6 9.5 0.8 10.3
3 5.7 15.2 2.8 0 6.7 0.9 4.3 0 5.9 4.7 0 0.9 2.1 1.9 0.6 3 3.6
1.3 3.4 1 0.1 0 1.3 2.6
1.5 1.2 3.5
0.7 1.5
5.9
Legend 0-1.0 . 1.1-5.0
5.1-10.0 0 300 600 1,200 Miles 10.1 and above Source: Author’s tabulation of data from NY State Department of Health Figure 2: Average Distance in 100 Miles to New York by State, 1971-1972
20.7
3.4 15.8 10.5 2.7 21.6 7.5 2.3 17.9 2.1 10.1 5.1 0 1.7 2.7 1.5 14.1 0.8
7.3 1.3 0.4 9.6 20.1 2.6 1.9 1.2 17 5.1 4.3 22.2 13.8 3.1 3.4 9.8 7.6 4.9
4.7 6.5 10.9 18.8 15.7 9.1 6
9.2 8.1 7.2
13.2 10.9
9.9
Legend . 13 states, NY "catchment area"
22 states, non-repeal, non-reform 0 300 600 1,200 Miles 14 states, repeal or reform Source: Author’s tabulation of data from NY State Department of Health Figure 3: Resident Abortion Rates for Abortions Performed in NY, 1973 Abortions per 1000 women 15-44
0
5.3 0.5 0.3 1.4 0 0.5 3 0 4.4 0.1 0.5 33.9 7.5 1.4 7.7 0.3 6.1
0.8 2.5 13.3 0.6 0 3.3 0.2 1.4 0 1.6 2.5 0 0.1 0.8 0.4 0.1 1.7 1.9
0.5 1.3 0 0.1 0 1.1 1.6
0.7 0.2 1
0.1 0.8
0.5
Legend 0-1.0 . 1.1-5.0
5.1-20.0 0 300 600 1,200 Miles 20.1 and up Source: NY State Department of Health Figure 4:Resident Abortion Rates for Abortions Performed in NY, 1975 Abortions per 1000 women 15-44
0
0.7 0.1 0 0.1 0 0.1 0.7 0 0.4 0 0.1 34.2 0.6 0.1 0.6 0 3.2
0.1 1 6.4 0 0 0.2 0.1 0.2 0 0.4 0.3 0 0 0.3 0.1 0 0.1 0.3
0.1 0.1 0 0 0 0.1 0.2
0 0.1 0
0 0
0.1
Legend 0-1.0 . 1.1-5.0
5.0-20.0 0 300 600 1,200 Miles 20.1 and up Source: NY State Department of Health Figure 5A: Resident Abortion Rates by Distance to the Nearest New York Legal Abortion Provider 1971-1972 by states 49 States 13 States 40
Abortion Rate=9.34-3.35*Ln(Distance) Abortion Rate = 10.69 - 3.57 *Ln(Distance) R-Squared = 0.83 R-Squared = 0.94
30 NY NY 20
NJ NJ
CTMA CT MA 10 RI RI
Resident Abortion Rate per 1000 Women Abortion per Rate Resident NHVT NH VT MIME MI ME OH OH PA IL FL PA IL DE IN IN KY GA TNIAMO WISC MN NE WVVA MT DC NC ARMS NDLA MD AL SDOK COWY KS TX NV 0 NM UTID AZ WAORCA
0 5 10 15 20 25 0 1 2 3 4 5 Distance to the Nearest Legal Abortion Services in 00s of Miles Distance to the Nearest Legal Abortion Services in 00s of Miles
*All abortions performed in New York State
Figure 5B: Resident Abortion Rates by Distance to the Nearest New York Legal Abortion Provider 1971-1972 by states 49 States 13 States 40
Abortion Rate = 7.84 - .48 * Distance Abortion Rate = 16.24 - 2.90 * Distance
30 NY R-Squared = 0.35 NY R-Squared = 0.45 20
NJ NJ
CTMA CT MA 10 RI RI NHVT NH VT MIME MI ME OH OH PA IL FL PA IL DE IN IN KY TNGA IAMNMO NE WV WISC Resident Abortion Rate per 1000 Women Abortion per Rate Resident VA MS ND MT MDDC NC AL AR OKLA CO KSSD TXWY NV 0 NM UTID AZ WAORCA
0 5 10 15 20 25 0 1 2 3 4 5 Distance to the Nearest Legal Abortion Services in 00s of Miles Distance to the Nearest Legal Abortion Services in 00s of Miles
*All abortions performed in New York State
Figure 6A: Average Distance in Miles to the Nearest Abortion Provider with Abortion Bans in 31 States
6 21 44 293 245 16 36 9 125 33 245 184 4 4 245 19 201 1 2 167 42 311 5 144 8 44 184 265 253 1 276 37 394 265 88 118 154 54 381 205 51 163 163
132 113 108
452 234
8 . Legend
Abortion is legal within state 0 300 600 1,200 Miles Abortion is banned within state Source: Center for Reproductive Rights Figure 6B: Average Distance in Miles to the Nearest Abortion Provider with Abortion Bans in 17 States
6 20 44 292 132 15 34 9 38 5 168 124 4 4 132 77 201 1 2 24 16 58 5 99 7 36 182 61 28 1 275 33 49 133 13 93 15 54 140 205 44 148 26
131 92 20
20 161
8 . Legend
Abortion is legal within state 0 300 600 1,200 Miles Abortion is banned within state Source: Guttmacher Institute Table 1: Total Resident Abortions Reported by the CDC and New York State , 1971‐72 1971 1972 CDC NY % NY± CDC NY % NY Alabama 1501 957 0.64 2100 828 0.39 Alaska¥ 1191 45 0.04 1166 10 0.01 Arizona 416 59 0.14 2865 58 0.02 Arkansas 1061 370 0.35 1555 699 0.45 California¥ 103929 236 0.00 106307 152 0.00 Colorado* 4589 662 0.14 5428 238 0.04 Connecticut 7808 6779 0.87 8333 6376 0.77 Delaware* 1667 540 0.32 2193 546 0.25 DC¥ 11618 364 0.03 7352 143 0.02 Florida 9235 8847 0.96 11624 8085 0.70 Georgia* 4989 3276 0.66 7070 4149 0.59 Hawaii¥ 4127 6 0.00 4534 12 0.00 Idaho 29 24 0.83 20 20 1.00 Illinois 15982 13440 0.84 14091 14353 1.02 Indiana 4989 4766 0.96 5481 5842 1.07 Iowa 2834 1821 0.64 2356 1607 0.68 Kansas* 4017 288 0.07 4843 286 0.06 Kentucky 2268 2184 0.96 3132 2839 0.91 Louisiana 1135 1049 0.92 1210 1269 1.05 Maine 1345 1300 0.97 1690 1848 1.09 Maryland* 10001 1136 0.11 14929 483 0.03 Massachusetts 13230 10757 0.81 17581 14035 0.80 Michigan 14361 13705 0.95 14626 15522 1.06 Minnesota 3351 2510 0.75 2227 2106 0.95 Mississippi 344 617 1.79 870 796 0.91 Missouri 4582 2113 0.46 6953 3699 0.53 Montana 420 402 0.96 172 178 1.03 Nebraska 1093 907 0.83 1797 791 0.44 Nevada 40 37 0.93 1630 36 0.02 New Hampshire 1243 1179 0.95 1483 1595 1.08 New Jersey 21207 20465 0.97 22832 25733 1.13 New Mexico* 4936 41 0.01 1962 75 0.04 New York¥ 105642 112778 1.07 100615 116555 1.16 North Carolina* 6147 1703 0.28 11810 1257 0.11 North Dakota 252 229 0.91 148 145 0.98 Ohio 14209 13636 0.96 16666 17067 1.02 Oklahoma 1506 601 0.40 2843 453 0.16 Oregon* 6998 14 0.00 7178 18 0.00 Pennsylvania 20430 13466 0.66 22772 14255 0.63 Rhode Island 1697 1612 0.95 1869 2085 1.12 South Carolina* 2045 1283 0.63 3056 1820 0.60 South Dakota 170 128 0.75 116 91 0.78 Tennessee 2782 2681 0.96 4288 3247 0.76 Texas 2558 2358 0.92 16022 1131 0.07 Utah 51 31 0.61 730 33 0.05 Vermont 766 728 0.95 1052 889 0.85 Viriginia* 6995 2729 0.39 11187 1255 0.11 Washington¥ 14425 72 0.00 17809 27 0.00 West Virginia 896 844 0.94 1491 719 0.48 Wisconsin 5310 2010 0.38 3090 2400 0.78 Wyoming 190 72 0.38 269 49 0.18
Total 452607 257857 0.57 503423 277905 0.55 Source: Centers for Diseases Control (1972,1974); authors tablulations of abortions by state of residence performed in New York as collected by the New York State Department of Health. ± Proportion of all CDC abortions obtained in New York. ¥ State repealed its abortion law. * State reformed its abortion law. Shaded states included in the 13‐state sample. Table 2: Regressions of Resident Abortion Rates on the Natural Log of Distance to New York, 1971‐75* (1) (2) (3) (4) (5) (6) All 15-19 20-24 25+ White NonWhite row 1. Ln Distance*1971-72 ‐2.28*** ‐2.79*** ‐3.81*** ‐1.45*** ‐2.07*** ‐4.62*** (0.30) (0.51) (0.48) (0.16) (0.33) (0.95) 2. Δ mile 283 - 183 ‐0.99 ‐1.22 ‐1.66 ‐0.63 ‐0.90 ‐2.01 3. Δ mile 878 - 778 ‐0.28 ‐0.34 ‐0.46 ‐0.18 ‐0.25 ‐0.56 4. Δ using linear distance* ‐0.36*** ‐0.46*** ‐0.61*** ‐0.22*** ‐0.40*** ‐0.85***
5. Ln Distance*1973-74 ‐0.73* ‐1.04* ‐1.15* ‐0.45* ‐0.65* ‐2.16*** (0.29) (0.42) (0.49) (0.17) (0.29) (0.53)
6. Ln Distance*1971-72*Repeal¥ 0.12 0.54 0.28 ‐0.12 ‐0.01 0.96 (0.38) (0.68) (0.66) (0.17) (0.59) (0.98)
7. Ln Distance*1971-72*Reform€ ‐0.56 ‐1.09 ‐1.00 ‐0.19 ‐0.61 ‐1.13 (0.41) (0.73) (0.72) (0.15) (0.48) (1.07)
Mean abortion rate 12 states± 8.37 11.88 13.96 4.60 8.16 13.94 Mean abortion rate 34 states≠ 4.16 6.05 7.05 2.16 4.53 6.67
R2 0.97 0.95 0.98 0.99 0.96 0.97 N 245 245 245 245 220 220
* Except for the estimates in row 4, the figures in each column are from a separate estimate of equation (1) in the the text. The dependent variable is the resident abortion rate for abortions performed in New York from 1971‐1975 in 48 states and the District of Columbia. Alaska and Hawaii are not included. Distance is in hundreds of miles. The marginal effect of distance in rows 2 and 3 shows the change in abortion rates associated with an increase of 100 miles between the designated distances. The marginal effect in row 4 is from a separate regression with distance entered linearly instead of in logs. Standard errors adjusted for clustering at the state level are in parentheses. ±Mean abortion rate in 1971‐72 in 12 states of the New York "catchment area" (see Figure 2) ≠Mean abor on rate in 1971‐72 in all states less New York, reform and repeal states. ¥ The figure is (α1 + α4) from equation (1) in text; € (α1 + α3) from equation (1) in text. * p<.05, ** p<.01, *** p<.001 Table 3: OLS and IV Regressions of Age-Specific Birth Rates on Lagged Abortion Rates, 1972-73# Panel A: 49 States All Women Whites Nonwhites OLS IV OLS IV OLS IV (1) (2) (3) (4) (5) (6)
Abortion Ratet-1 ‐1.59*** ‐2.30*** ‐1.12*** ‐1.94*** ‐0.59* ‐1.36*** (0.31) (0.35) (0.30) (0.37) (0.27) (0.31)
F-stat, distance 65.2 31.7 20.1 N 294 294 264 264 264 264 R-sq 0.93 0.93 0.96 0.96 0.89 0.89 Panel B: 13 States
Abortion Ratet-1 ‐1.01** ‐0.99** ‐0.67 ‐0.60 ‐0.40 ‐0.43 (0.35) (0.35) (0.37) (0.39) (0.33) (0.39)
F-stat, distance 99.9 69.5 17.3 N 78 78 78 78 78 78 R-sq 0.96 0.96 0.98 0.98 0.86 0.86 # Each column wihin a panel is from a separate estimate of equation (2) in the text. The first-stage results for the IV estimates are in Appendix Table1. All models include state fixed effects. The 13 states include CT, IL, IN, ME, MA, MI, NH, NJ, NY, OH, PA, RI, VT. Race-specific abortion rates are missing in 5 states (ID, NV, NM, OR and UT). F-statistics are for the excluded instruments in the first-stage . *p<.05; ** p<.01; ***p<.001 Table 4: Projected Changes in Abortions in 2007 and Births in 2008 Were Abortion Banned in Selected States*
Abortions
All Whites ± Nonwhites Teens No. % ∆ No. % ∆ No. % No. % ∆ States (avg Δ distance) € 31 states ban (157) -178,804 -14.9% -134,491 -18.4% -70,040 -14.8% -36,204 -18.5% 17 states ban (69) -72,000 -6.0% -56,587 -7.7% -23,245 -4.9% -14,879 -7.6% 46 states ban (435) -354,870 -29.5% -265,134 -36.3% -145,455 -30.8% -71,527 -36.6%
Total in US 1,202,990 730,513 472,477 195,520
Births 31 states ban high 178,804 4.2% 134,491 4.1% 70,040 7.2% 36,204 8.3% low 100,838 2.4% 75,847 2.3% 39,499 4.1% 20,417 4.7% 17 states ban high 72,000 1.7% 56,587 1.7% 23,245 2.4% 14,879 3.4% low 40,605 1.0% 31,913 1.0% 13,109 1.3% 8,391 1.9% 46 states ban high 354,870 8.4% 265,134 8.1% 145,455 14.9% 71,527 16.5% low 200,131 4.7% 149,524 4.6% 82,030 8.4% 40,338 9.3%
Total in US 4,247,694 3,274,163 973,531 434,758
The change in abortions is obtained by subtracing the natural log of distance to the nearest abortion provider under a 31-state ban from log of distance as of 2008 multiplied by the age- and race-specific coefficients on log distance in Table 2. We divide this change by the current resident abortion rate (2007) to arrive at the percent change in the abortion rate associated with a ban. We then multipy the percent change in the abortion rate in each state by the current number of resident abortions in the state and sum the total. The change in births is based on the regression estimates from the 13-state sample in Table 3. The high estimate assumes each abortion prevents one birth. The low estimates assumes each abortion replaces 0.56 births which is based on a weighted average of the coefficients for whites and nonwhites in Table 3. The low estimated change in race-specific births assumes each abortion replaces 0.67 births among whites and 0.40 births among nonwhites based on the race-specific coefficients in Table 3.
€ Increase in distance to the nearest abortion provider in the states that ban abortion from the current distance (2008) to distance under the ban.
±The distributin of abortions by race had to be estimated based on the Guttmacher Institute's data on abortions to teens by race. They also pertain primarily to white non-Hispanics and black non-hispanics and thus the magnitudes by race should be interpreted cautiously Sources: Resident abortions are from the Guttmacher Institute http://www.guttmacher.org/datacenter/table.jsp#; Births are from the CDC:http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_01.pdf Appendix Table 1: First-stage Regressions of Age-Specific Abortion Rates on Log Distance (in 100 miles) interacted with Age: 1971-72#
Panel A: 49 States All Whites Nonwhites (1) (2) (3) Ln distance *Ages 15-19 ‐1.24*** (A=5.42)± (0.15)
Ln distance *Ages 20-24 ‐3.27*** (A=6.56) (0.15)
Ln distance *Age<20 ‐1.53*** ‐4.97*** ¥ (WA=6.34; NWA=8.60) (0.17) (0.57)
Ln distance *Age 20-29 ‐2.58*** ‐6.96*** (WA=5.60; NWA=8.66) (0.17) (0.57)
N 294 264 264 R-sq 0.97 0.95 0.90 Mean Distance, in 00s miles 8.28 7.12 7.12 F-stat, distance 65.18 31.68 20.10 Panel B: 13 States Ln distance *Ages 15-19 0.03 (A=13.13)± (0.23)
Ln distance *Ages 20-24 ‐2.79*** (A=16.55) (0.23)
Ln distance *Age<20 ‐0.33 ‐3.32* (WA=12.89; NWA=24.24) (0.21) (1.31)
Ln distance *Age 20-29 ‐2.29*** ‐7.66*** (WA=12.46; NWA=23.75) (0.21) (1.31)
N 78 78 78 R-sq 0.98 0.97 0.87 Mean Distance, in 00s miles 2.16 2.16 2.16 F-stat, distance 99.85 69.54 17.28 Estimates of equation (3) in the text. Model includes main effects for age, state covariates (see text), and state and year fixed effecs as well as age‐state, distance‐state and age‐state‐distance interactions. The 13 states include CT, IL, IN, ME, MA, MI, NH, NJ, NY, OH, PA, RI, VT. ¥Five states (ID, NV, NM, OR, UT) lack data on race‐ specific abortions. The mean white/ nonwhite abortion rates pertain to the available 44 states sample Appendix Table 2: Projected Changes in Abortions 2007 and Births in 2008 Were Abortion Banned in Selected States from Models with Distance in Miles*
Abortions
All Whites ± Nonwhites Teens No. % ∆ No. % ∆ No. % No. % ∆ States (avg distance) 31 states ban (157) -90,027 -7.5% -57,431 -7.9% -45,865 -9.7% -12,373 -6.3% 17 states ban (69) -22,642 -1.9% -15,581 -2.1% -9,895 -2.1% -3,455 -1.8% 46 states ban (435) -349,957 -29.1% -211,678 -29.0% -194,984 -41.3% -47,218 -24.1%
Total in US 1,202,990 730,513 472,477 195,520
Births 31 states ban high 90,027 2.1% 57,431 1.8% 45,865 4.7% 12,373 2.8% low 50,775 1.2% 32,391 1.0% 25,868 2.7% 6,978 1.6% 17 states ban high 22,642 0.5% 15,581 0.5% 8,329 0.9% 3,530 0.8% low 12,770 0.3% 8,787 0.3% 5,581 0.6% 1,949 0.4% 46 states ban high 349,957 8.2% 211,678 6.5% 147,204 15.1% 48,244 11.1% low 197,376 4.6% 119,386 3.6% 109,971 11.3% 26,631 6.1%
Total in US 4,247,694 3,274,163 973,531 434,758
The change in abortions is obtained as follows. We computed the percent change in the abortion rate in 1971-72 per 100 mile increase in distance from New York based on the estimates from the linear model in Table 2. We multiplied the percent change by the increase in distance associated with a ban to calculate the decrease in the number of resident abortions in the state in 2007. We then summed the change in each state. The change in births is based on the regression estimates from the 13-state sample in Table 3. The high estimate assumes each abortion is replaced by one birth. The low estimates assumes each abortion replaces 0.564 births which is based on a weighted average of the coefficients for whites and nonwhites in Table 3. The low estimated change in race-specific births assumes each abortion replaces 0.67 births among whites and 0.40 births among nonwhites based on the race-specific coefficients in Table 3.
±The distributin of abortions by race had to be estimated based Guttmacher data on abortions to teens by race. They also pertain primarily to white non-Hispanics and black non-hispanics and thus the magnitudes by race should be interpreted cautiously
Sources: Resident abortions are from the Guttmacher Institute http://www.guttmacher.org/datacenter/table.jsp#; Births are from the CDC:http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_01.pdf